“In a fast-changing health care system, one thing is constant: Nurses have always played, and will always play, a pivotal role,” Robert Wood Johnson Foundation (RWJF) Senior Adviser for Nursing Susan B. Hassmiller, PhD, RN, FAAN, wrote in the November issue of Health Affairs. “From the design to the delivery of care, from prevention to clinical practice to policy, and from research to reimbursement issues, nurses are at the very center of care.”
The November issue focused on redesigning the health care workforce, including changing models of care and care delivery, reforming laws and policies that limit practitioners’ ability to provide care, and more. It featured studies finding that relying more heavily on nurses, and ensuring they can practice to the full extent of their education and training, can help mitigate the looming primary care physician shortage and reduce health care costs.
Models of care that rely less on physicians and more on nurse practitioners (NPs) or physician assistants (PAs) could ease—or even eliminate—the anticipated primary care physician shortage , according to one study in the issue. David Auerbach, MS, PhD, a policy researcher at the RAND Corporation, and colleagues estimate that there will be a “much stronger” increase in the number of NPs and PAs relative to physicians between 2010 and 2025, resulting in a shortage of physicians and a surplus of NPs and PAs. The researchers also found that nurse-managed health centers and patient-centered medical homes use higher proportions of NPs and Pas than traditional models of care while providing care to the same patient populations.
The research team estimates that the primary care physician shortage could be cut by about a quarter if medical homes or nurse-managed health centers provided a greater proportion of the nation’s primary care in 2025. Increasing the prevalence of both delivery models so that they delivered roughly half of all primary care would cut the physician shortage nearly in half, the study finds.
Another study in the Health Affairs special issue examines the cost-savings associated with NPs providing primary care in retail clinics. That research team estimates that these nurse-led clinics—often based in pharmacies, grocery stores and other “big box” stores—will account for about 10 percent of outpatient primary care visits by 2015, resulting in nearly $2.2 million in cost savings.
Those retail clinics have already been shown to provide quality care and reduce health care costs, the study says, and they could save the nation even more money if NPs were allowed to practice independently. By comparing insurance claims from retail clinics and with those from other settings, the researchers found that the savings would be increased by $810 million by 2015 if all states allowed NPs to practice independently, and by $472 million if NPs were allowed to practice and prescribe independently.
The study was led by Joanne Spetz, PhD, professor at the Institute for Health Policy Studies and associate director for Research Strategy at the Center for the Health Professions at the University of California, San Francisco, and Stephen T. Parente, director of the Medical Industry Leadership Institute at the Carlson School of Business, University of Minnesota.
The Future of Nursing
In her article, Hassmiller notes that RWJF has long recognized nurses’ important contributions to the health care system as evidenced by its 40 years of investment in nurses and nursing programs. She outlines the Foundation’s support for nursing and how it has evolved over the years, preparing nurses for the challenges that lie ahead, creating opportunities for them to practice and lead, and bringing philanthropic and other diverse partners to this work.
Through its support for the Future of Nursing: Campaign for Action, Hassmiller writes, the Foundation is helping “reshape and reimagine the nation’s nurse workforce.” The Campaign is working to advance the recommendations from of the Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health, including those that will affect the feasibility and function of the models of care explored in Health Affairs.
Hassmiller explains: “Specifically, the IOM report recommended changes that echoed the profession’s aims, including removing barriers that prevent nurses from practicing to the full extent of their training and abilities, fostering interprofessional collaboration so that nurses can be full partners with physicians and other professionals in redesigning health care to better serve patients, improving nurse education, creating an infrastructure for nurse workforce data collection, diversifying the nurse workforce, and preparing and enabling nurses to lead change.”
Improving health and health care for all Americans cannot be done without a strong, well-prepared nursing workforce empowered to lead change, she writes.
The study by Auerbach is part of the Future of Nursing National Research Agenda, a project of RWJF, and was co-funded by the Donaghue Foundation. The study by Spetz and Parente was funded by RWJF's Interdisciplinary Nursing Quality Research Initiative (INQRI).